Guidelines of Okumura et al for the Health Care Worker Response to a Chemical Mass Casualty Event

Description

Okumura et al provide guidelines for the response of health care workers (HCW) to a chemical mass casualty event. These are based on experiences with the Tokyo subway sarin attack by the Aum Shinrikyo cult in 1995. The authors are from Juntendo University and St. Luke's International Hospital in Tokyo.

General steps:

(1) Triage the patient for decontamination.

(2) Adjust health care worker personal protective equipment (PPE) to reduce secondary exposure to toxins while treating the patient.

Patient Status	Causative Agent	Initial Decontamination	Treatment Priority
able to walk ("walkable")	invisible	self-service dry decon	4
	visible	self-service wet showering	3
	skin irritation present	self-service wet showering	3
unable to walk ("unwalkable")	invisible	dry decon	2
	visible	wet decon	1
	skin irritation present	wet decon	1

Sources of secondary exposure:

(1) fluid from gastric lavage

(2) air from lungs

(3) from clothing or skin if incomplete decontamination

(4) fluids from washing areas not reached during decontamination

If health care workers develop symptoms while caring for the patient, then

(1) additional PPE should be provided

(2) an attempt should be made to identify the source of secondary exposure so that an appropriate response can be made (increase ventilation, change decontamination procedure, alter triage or take-in process, etc.)

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Description

Specialty

ICD-10